Minerva pediatrica
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Endotracheal intubation is frequently performed in neonatal intensive care. This procedure is extremely distressing and painful, and it has the potential for causing laryngospasm, hemodynamic changes, a rise in intracranial pressure and a risk of hemorrhage and airway injury. These adverse changes can be attenuated by using premedication with analgesic, sedative and muscle-relaxant drugs. ⋯ In Italy, a recent survey (in press) showed that the majority of NICU (Neonatal Intensive Care Units) use the sa me association of drugs for analgesia and sedation before tracheal intubation, but "not always" in more than half of these units. There is clearly a persistent concern about using such drugs in preterm and newborn infants, despite recent evidence showing that premedication for elective neonatal intubation is safer and more effective than when the infant is awake. Here we review the effects of using analgesic and sedative drugs on intubation conditions (good jaw relaxation, open and immobile vocal cord, suppression of pharyngeal and laryngeal reflex), on the time it takes to complete the procedure successfully, on pain control and the potentially adverse effects of using combinations of drugs for sedation.
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Chylothorax is the accumulation of chyle in the pleural space. In newborns the congenital form is often prenatal diagnosed, while the late variety originates to damage to the thoracic duct by cardiac surgery, diaphragmatic hernia, etc. Clinical presentation results from the accumulation of pleural fluid and the symptoms depends on the size of the effusion. ⋯ Surgery should be considered when medical management fails. Some approaches are reported, and thoracic duct ligation, pleurodesis and pleuroperitoneal shunts are the most utilized. The prognosis of chylothorax depends on the etiology, and it is consequence of a variety of treatments that may influence the outcome.
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Review Comparative Study
New diagnostic and therapeutic options in bacterial meningitis in infants and children.
Bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children through the world. Current strategies to prevention and therapy of bacterial meningitis are compromised by incomplete understanding of the pathogenesis, emergence of antimicrobial resistant microorganisms and lack of simple diagnostic tools in resource-limited settings. ⋯ Suspected bacterial meningitis is a medical emergency and requires empiric antimicrobial therapy without delay, but recognition of pathogens with increasing resistance to antimicrobial agents is an important factor in selection of empiric antimicrobial regimen. A more complete knowledge on the pathogenesis of meningitis is likely to help in development of new diagnostic and therapeutic options for infants and children with bacterial meningitis.
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Parenteral nutrition associated liver disease is the most common complication of pediatric short bowel syndrome (SBS). There is emerging evidence that the disease may be reversed with the use of parenteral lipid emulsions derived from fish-oils, which contain significant concentrations of omega-3 fatty acids (w3FA). This paper will review the rationale for the use of parenteral lipid emulsions containing w3FA in SBS and the evidence for their efficacy. Given the promising results and apparent safety of these emulsions, we shall also consider what the current role for PN lipid emulsions containing w3FA in children with SBS should be.